Tuberculosis of the upper respiratory tract, trachea and bronchi

Respiratory tract tuberculosis is considered a complication of pulmonary tuberculosis or intrathoracic lymph node tuberculosis. Only in very rare cases is respiratory tract tuberculosis an isolated lesion without clinically established tuberculosis of the respiratory organs.

Epidemiology of tuberculosis of the upper respiratory tract, trachea and bronchi

Among all the localizations of tuberculosis of the respiratory tract, bronchial tuberculosis is mainly observed. In patients with various forms of intrathoracic tuberculosis, it is diagnosed in 5-10% of cases. Less often, laryngeal tuberculosis is observed. Tuberculous lesions of the oropharynx (uvula, tonsils) and trachea are rare.

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Pathogenesis and pathological anatomy of tuberculosis of the upper respiratory tract, trachea and bronchi

As a rule, tuberculosis of the respiratory tract complicates untimely diagnosed and untreated pulmonary tuberculosis or a process caused by drug-resistant mycobacteria.

Tuberculosis of the bronchus often occurs as a complication of primary, infiltrative and fibrous-cavernous tuberculosis. In patients with primary tuberculosis, granulation from the adjacent caseous-necrotic lymph nodes grows into the bronchus. Mycobacteria can penetrate the bronchial wall by the lymphogenous route. In infiltrative and fibrous-cavernous tuberculosis, the infection spreads from the cavern to the submucosal layer of the bronchus. Hematogenous infection of the bronchial wall is of lesser importance.

Tuberculosis of the bronchus can be infiltrative and ulcerative. The process is characterized mainly by productive and, less often, exudative reactions. In the wall of the bronchus, typical tuberculous nodules are formed under the epithelium, which merge with each other. A poorly defined infiltrate of limited extent with a hyperemic mucous membrane appears. With caseous necrosis and disintegration of the infiltrate, an ulcer is formed on the mucous membrane covering it, and ulcerative tuberculosis of the bronchus develops. Sometimes it is combined with a nodulobronchal fistula, which begins from the side of the caseous-necrotic lymph node in the root of the lung. Penetration of infected masses through the fistula into the bronchus can be the cause of the formation of foci of bronchogenic seeding in the lungs.

Tuberculosis of the larynx can also be infiltrative or ulcerative with a predominantly productive or exudative reaction. The defeat of the inner ring of the larynx (false and true vocal folds, subglottic and interarytenoid spaces, Morganian ventricles) occurs as a result of infection with sputum, and the defeat of the outer ring (epiglottis, arytenoid cartilages) - by hematogenous or lymphogenous introduction of mycobacteria.

Symptoms of tuberculosis of the upper respiratory tract, trachea and bronchi

Tuberculosis of the bronchus develops gradually and proceeds asymptomatically or with complaints of a dry persistent cough, cough with the release of crumbly masses, pain behind the sternum, shortness of breath. An infiltrate in the bronchial wall can completely close its lumen, due to which shortness of breath and other symptoms of impaired bronchial patency may appear.

Symptoms of laryngeal tuberculosis include hoarseness up to aphonia, dryness and sore throat. Pain when swallowing is a sign of damage to the epiglottis and the posterior semicircle of the entrance to the larynx. The disease develops against the background of the progression of the main tuberculosis process in the lungs. Symptoms of laryngeal damage may be the first clinical manifestation of tuberculosis, most often asymptomatic disseminated pulmonary tuberculosis. In such cases, detection of pulmonary tuberculosis provides grounds for establishing a diagnosis of laryngeal tuberculosis.

Diagnosis of tuberculosis of the upper respiratory tract, trachea and bronchi

In the diagnosis of respiratory tuberculosis, it is important to consider its connection with the progression of pulmonary tuberculosis and intrathoracic lymph nodes. The limited damage to the mucous membrane is also characteristic.

X-ray examination and especially CT reveal deformation and narrowing of the bronchi. A characteristic X-ray picture occurs when tuberculosis of the bronchus is complicated by hypoventilation or atelectasis.

In cases of ulcerative forms of tuberculosis of the respiratory tract, Mycobacterium tuberculosis may be detected in the sputum of patients.

The main method of diagnosing tuberculosis of the respiratory tract is considered to be examination using a laryngeal mirror, laryngoscope and fiber bronchoscope, which allows examining the mucous membrane up to the mouth of the subsegmental bronchi. In the absence of destructive pulmonary tuberculosis, endoscopic examination helps to determine the source of bacterial excretion, which is usually an ulcerated bronchus or (extremely rarely) trachea.

Tuberculous infiltrates in the larynx and bronchi can be grayish-pink to red, with a smooth or slightly bumpy surface, dense or softer consistency. Ulcers are irregular in shape, with corroded edges, usually shallow, covered with granulation. In cases of rupture of caseous-necrotic lymph nodes into the bronchus, nodular-bronchial fistulas are formed, granulation grows.

For morphological and bacteriological confirmation of the diagnosis of tuberculosis, various methods of collecting material and biopsy are used. The discharge from ulcers, discharge from the fistula opening, and granulation tissue are examined for the presence of mycobacteria.

Involution of bronchial tuberculosis ends with the formation of fibrous tissue - from a small scar to cicatricial stenosis of the bronchus.

Treatment of tuberculosis

• Chemotherapy for tuberculosis
• Anti-tuberculosis drugs
• Surgical methods of treatment of tuberculosis
• Treatment of extrapulmonary tuberculosis
• Pathogenetic therapy of tuberculosis
• Immunotherapy in the treatment of tuberculosis
• Physical methods of treating tuberculosis
• Methods of extracorporeal hemocorrection in tuberculosis
• Prevention of tuberculosis (BCG vaccination)
• Chemoprophylaxis of tuberculosis

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